28: Cost-Effectiveness Analysis Comparing Pre-Diagnosis Treatment for Autism Spectrum Disorder with the Ontario Autism Program
Bibliographic record
Abstract
Autism Spectrum Disorder (ASD) is associated with significant lifetime costs. The Early Start Denver Model (ESDM) has shown efficacy in children with ASD as young as 18 months. New service delivery models propose providing ASD-targeted treatment to young children who show signs of ASD before a diagnosis. There are no studies examining the cost-effectiveness of this model. We performed a cost-effectiveness analysis comparing the costs and dependency-free life years (DFLYs) generated by pre-diagnosis intensive ESDM (ESDM-I), pre-diagnosis parent-delivered ESDM (ESDM-PD) and the Ontario Status Quo (SQ). We took a government perspective and a time horizon to age 65. We constructed a decision-analytic model delineating three treatment pathways. We assumed 37% of children received Early Intensive Behavioural Intervention (EIBI). The ESDM-I and ESDM-PD contributed gains of 17.6 and 4.94 IQ points, respectively. These were added to expected mean IQs for children who enter EIBI before and after age four, and those who do not receive EIBI. IQ outcomes were stratified into >70 and <70. Each IQ stratum was assigned a probability of achieving an Independent (60 DFLYs), Semi-Dependent (30 DFLYs) or Dependent (0 DFLYs) outcome. Costs for each pathway were determined using the budget of an ESDM pilot project and government publications. An incremental cost-effectiveness ratio (ICER) was calculated. Discount rates of 0%, 3% and 5% were applied and a probabilistic sensitivity analysis was conducted to account for variability in costs and effects. With no discount rate applied, the SQ program cost an average of $380,000 per child over the lifetime and generated an average of 4.23 DFLYs. The ESDM-PD had an average cost of $386,000 and generated 6.86 DFLYs. The ESDM-I cost $410,000 for 7.36 DFLYs. The ICER for ESDM-PD compared to SQ was $2400 per DFLY gained, and the ICER for ESDM-I compared to SQ was $9,500 per DFLY gained. The ICER for the ESDM-I compared to the ESDM-PD was $47,500 per DFLY gained. The pattern of increasing costs and increasing effectiveness remained for both the ESDM-PD and ESDM-I when 3% and 5% discount rates were applied. From a government payer perspective, parent-delivered, pre-diagnosis ASD interventions may offer an efficient model for service delivery. Our model did not produce the savings seen in previous economic evaluations due to use of poorer prognostic expectations in our analysis. More prognostic evidence is needed for adults with ASD, particularly those who have received EIBI.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.017 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.006 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".